This invention relates to an electrosurgical electrode for an adenoidectomy surgical procedure.
Adenoidectomy is indicated for the relief of nasal obstruction, sleep apnea, recurrence of chronic infection, and for chronic ear disease. The procedure is the surgical removal of hypertrophic adenoid tissue from the posterior nasal cavity and along the torus. The procedure as such is well known using conventional curettes and is described in detail in Surgical Pediatric Otolaryngology edited by Potsic, Cotton, and Handler, Pages 234-235 and FIG. 20-1A-H, published 1997 by Thieme of New York, the contents of which are incorporated herein by reference.
Adenoidectomy continues to be one of the most commonly performed operations in children in the 20th Century. The gold standard for adenoidectomy is the conventional curette. A major problem using conventional curettes besides persistent bleeding is visualization. Moreover, general anesthesia is always required and a 1-3 day hospitalization of the patient as well. Postoperative packing of the surgerized area is always needed to control and contain post-operative bleeding. A special liquid diet is always prescribed post-operatively.
An object of the invention is an improved adenoidectomy surgical procedure.
We have invented a novel unipolar electrode for use in an electrosurgical adenoidectomy procedure. This electrosurgical procedure using our novel electrode enables physicians to offer to patients a treatment that is efficiently performed, easily learned and thus performed at a significantly reduced price, and with less tissue damage and superior results compared to procedures done with a scalpel-curette.
The procedure using our novel electrode is based on the incising of a portion or all of an area of the adenoid by intranasal electrosurgery, i.e., via the nasal passageway. The electrode of the invention is uniquely configured to enable the active tip to reach and incise the hypertrophic adenoid tissue while avoiding damage to surrounding tissue.
In a preferred embodiment, our novel electrode is characterized by an elongated electrically-insulating body portion having at a proximate end an electrical connector for receiving electrosurgical RF currents and a fitting for receiving a suction conduit. The electrical connector is internally connected to an active electrode at the distal end of the body portion, which active electrode comprises a bare sharp blade extending across the arms of a claw-shaped end of the body portion. Viewed from the top, the claw-shaped end curves downward, the blade extends in a direction perpendicular to an extension of the longitudinal axis of the body portion, and the sharp cutting edge of the blade faces upwardly. Terminating just behind the claw-shaped end and facing the curved claw-shaped end is a nozzle opening of a suction conduit housed in the body portion and connected to the fitting. The tissue excising is effected with the bare blade cutting edge moved by the surgeon in a generally upward path after the elongated body portion has been introduced into the nasal cavity. The insulated parts of the body portion help position and guide the active blade edge during the surgical procedure. The electrosurgical procedure has the very important advantage of being able to excise the adenoid tissue portions while at the same time coagulating the cut tissue causing minimum bleeding. It is preferred that the electrosurgical currents used be above 2 MHz, and preferably above 3 MHz. At these RF high frequencies, commonly referred to as radiosurgery, cutting is accomplished by volatilizing intracellular fluids at the point of the transmitting electrode contact which is primarily responsible for only small lateral heat spread and thus less damage to neighboring cell layers by keeping tissue temperature lower.
The advantages of using the RF adenoid curette of the invention include:
a) the procedure can be done in the office and a hospital environment is unnecessary as the RF adenoid curette procedure is done with local anesthesia not general;
b) the RF low temperature energy source connected to the RF adenoid curette probe enables precise micro cutting of the curette RF blade into adenoid tissue;
c) no post-operative packing is normally necessary;
d) there is a clear unobstructed view of the surgical site with the adenoid probe of the invention;
e) no special diet is necessary.
When used herein with respect to the probe of the invention, the term xe2x80x9cdownwardxe2x80x9d means, with the probe held horizontally with its longitudinal axis extending horizontally, as illustrated in FIG. 1 below, in a southerly direction (toward the bottom margin of the drawing) transverse to the longitudinal axis. The term xe2x80x9cbelowxe2x80x9d means positioned underneath the axis with the probe held in the same position shown in the drawing. The term xe2x80x9cupwardxe2x80x9d means in the reverse northerly direction, and the term xe2x80x9cabovexe2x80x9d similarly means above the axis with the probe held in the same position shown in the drawing.